Professor, Chief of Urology, and Director of GU Oncology; University of Montreal Hospital Centres

Prostate cancer is the third-leading cause of cancer death in Canadian men. "Approximately one in seven Canadian men — or just over 21,000 — were diagnosed with prostate cancer in 2017 and about 4,000 of them died from the disease," says Dr. Stuart Edmonds, Vice President of Research, Health Promotion, and Survivorship at Prostate Cancer Canada.

While survival rates are extremely high when prostate cancer is diagnosed early — close to 100% five years after diagnosis, they diminish when the disease is discovered in later stages. However, thanks to recent treatment discoveries and innovations, Canadian men diagnosed with advanced prostate cancer have reason to be more hopeful and optimistic. "These discoveries have led to a number of different options that can extend lives considerably," says Dr. Edmonds.

Hormonal therapies offer hope

Historically, patients diagnosed with advanced prostate cancer that had spread to other parts of the body were treated with a hormone therapy known as androgen deprivation therapy. "Prostate cancer depends on testosterone to thrive so if you cut off the source of testosterone, patients can go into remission, sometimes for several years," says Dr. Fred Saad, Professor, Chief of Urology, Director of GU Oncology at the University of Montreal Hospital Centres.

The chances of having our patients live longer has gone up tremendously over the past few years.
– Dr. Fred Saad

Unfortunately, many of these patients experience a recurrence after a couple of years on the androgen deprivation therapy — a condition known as metastatic castration-resistant prostate cancer. Chemotherapy, a new form of targeted radiation therapy, and a new generation of oral targeted hormonal treatments are helping men who have castration-resistant cancers experience longer and better lives. "There's a lot more we can offer these patients now, so the chances of having our patients live longer has gone up tremendously over the past few years," says Dr. Saad.

These new hormonal drugs can significantly increase survival and quality of life. "They act by targeting the androgen receptor that stimulates the cancer to grow and are easier for patients to tolerate," says Dr. Saad. In addition to being used in patients with advanced cancers, these new targeted hormonal therapies can be used to treat patients who are at high risk of becoming metastatic by preventing or delaying metastasis. "It's a huge change in the way we view prostate cancer," says Dr. Saad.

PSA test more than a diagnostic tool

The prostate-specific antigen (PSA) test is a valuable tool for both early detection and determining which men living with prostate cancer are more likely to have an aggressive form of the disease. "PSA has a role in diagnosis, and an even a bigger role once we treat the patient since PSA should go down and stay down. If patients recur, PSA allows us to detect this early and helps to decide how and when to treat based on how fast PSA goes up. This is the best predictor of what will happen to the patient," says Dr. Saad.

The PSA test, in combination with the grade of cancer, is also a way to help avoid overtreatment of low-risk patients. "We want to be able to identify and treat the cancers that men will die of, as opposed to die with, and the PSA is a great entry point for doing that," adds Dr. Edmonds.

Wherever they are in their prostate health journey, men — especially those between the ages of 50 and 70 who are at an increased risk — should speak to their doctor about getting tested.